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Section 3. Summaries of Infectious Diseases
Staphylococcal Infections
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Staphylococcus aureus causes a variety of localized or invasive suppurative infections and 3 toxin-mediated syndromes: toxic shock syndrome (see Toxic Shock Syndrome, p 624), scalded skin syndrome, and food poisoning (see Staphylococcal Food Poisoning, p 559). Localized infections include hordeola, furuncles, carbuncles, impetigo (bullous and nonbullous), paronychia, ecthyma, cellulitis, parotitis, lymphadenitis, and wound infections. Staphylococcus aureus also causes foreign body infections, including infections associated with intravascular catheters or grafts, pacemakers, peritoneal catheters, cerebrospinal fluid shunts, and prosthetic joints, which may be associated with bacteremia. Bacteremia can be complicated by septicemia, endocarditis, pericarditis, pneumonia, pleural empyema, muscle or visceral abscesses, arthritis, osteomyelitis, septic thrombophlebitis of large vessels, and other foci of infection. Meningitis is rare. Staphylococcus aureus infections can be fulminant and commonly are associated with metastatic foci, abscess formation, and foreign bodies. These infections often require prolonged antimicrobial therapy, abscess drainage, and foreign body removal to achieve cure. Risk factors for severe staphylococcal infections include chronic diseases, such as diabetes mellitus, cirrhosis of the liver, and nutritional disorders; surgery; transplantation; disorders of neutrophil function; and acquired immunodeficiency syndrome.
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Staphylococcal scalded skin syndrome (SSSS) is an S aureus toxin-mediated disease caused by circulation of exfoliative toxins A and B. The manifestations of SSSS are age-related and include Ritter disease (generalized exfoliation) in the neonate, a tender scarlatiniform eruption and localized bullous impetigo in older children, and a combination of these with thick white/brown flaky desquamation of the entire skin, especially on the face and neck, in older infants and toddlers. The hallmark of SSSS is the toxin-mediated cleavage of the stratum granulosum layer of the epidermis. Healing is without scarring. Bacteremia is
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